Provider Demographics
NPI:1659603157
Name:GAMAL F GHALY MD INC A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:GAMAL F GHALY MD INC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GAMAL
Authorized Official - Middle Name:F
Authorized Official - Last Name:GHALY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-243-2045
Mailing Address - Street 1:14114 BUSINESS CENTER DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-9113
Mailing Address - Country:US
Mailing Address - Phone:951-656-5333
Mailing Address - Fax:951-243-2074
Practice Address - Street 1:14114 BUSINESS CENTER DR
Practice Address - Street 2:SUITE G
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-9113
Practice Address - Country:US
Practice Address - Phone:951-656-5333
Practice Address - Fax:951-243-2074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-08
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44392207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty